Next President Must Change Course on PEPFAR

Deepali Gaur Singh

Rather than targeting the most at-risk populations, ideological provisions in PEPFAR marginalize sex workers and all women. The next administration can take the ideology out.

India does not make the list of the fifteen focus countries targeted by the President’s Emergency Plan for
, with Vietnam
being the only representative from the continent. And yet the traditional
make-up of the country, the emphasis on cultural mores and rituals and
the contesting contexts and sub-contexts within the country, could easily act as an example for many parts of the world.

Here, like in many other countries, change is welcome as long as it does not disturb the
traditional set-up of communities. Dislodging
cultural practices, many of which might be gender imbalanced, continues
to meet with opposition in the pursuit of preservation of this cultural
ethos. And marriage is at the heart of most of the traditions guiding
Indian society. A good marriage is where the woman redeems herself and
a bad marriage is a curse she brings upon herself.

Therein lies the problem with the prostitution pledge PEPFAR grantees are obligated to sign. Fathers of girl(s),
even today, in many parts of the country carry the "burden" of the
girl until the time he finds a suitable groom only to shift that burden
on to him. Hence, one of the easiest and oldest ways of luring unsuspecting
girls and women into the sex trade is the promise of matrimony. Brought
up amidst strong representations of virtue and honor, these are women
who even when rescued from the labyrinthine network of the industry
hesitate to return to their communities for fear of ostracism or the "shame" that they bring to the family. Thus, they are often compelled
to return to the very life they long fight to leave. So are these young
lives condemned to a life of stigma and discrimination and to be deprived
of medical care and attention simply because they reconciled to sex
work as their only means of survival. In a society where these women
suffer a near pariah status the availability or non-availability of
aid hinged on the prostitution pledge, in effect, is institutionalizing
their vulnerability by covertly stating that these women do not deserve
care and support because of the work they do.

Given the prevalence of HIV
among sex workers, migrant workers, and the wives migrant workers return to, groups working within these communities are bound to find the prostitution pledge
a major hindrance while attempting to provide legal, social and health
services or in aiding in whatever way possible these sex workers. The prostitution pledge undermines the very
programs that so far have proved the most successful in reversing
the spread of the virus. It in effect excludes from its group of beneficiaries
a substantial portion of the high risk populations in the country and
also keeps out groups that do not fit into the high risk category.

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So while a sex worker is denied care
because the mode of transmission (sex work), the man transmits HIV to his spouse or to other partners due to decreased funding for condom provision or the lack of ability among sex workers to negotiate
for condom use. What the "most-at-risk" group clause in PEPFAR does, then, is to keep HIV education, counseling and care out of the reach
of these women who contract it from their husbands
— since they are not
considered within the vortex of these high risk groups.

Married women form a substantial component
of the HIV infected population mainly because of early marriages to
much older and often already sexually active men. In the absence of
information on the subject — since sex itself is a taboo subject —
they very rarely are equipped to protect themselves from infections.
Pregnancy is the entry point to discuss other issues like reproductive
and sexual health, HIV/AIDS and even abortion.

This is significant in many cultural contexts in which contraception is socially and morally criminalized, leaving women
with very few options of birth control. While a miniscule minority might
be able to exercise their choice of timing the pregnancies and the use
of contraceptives, by and large this choice is not available to most.
For a long time midwives are the closest pregnant women have come to any kind
of structured health care during and after their childbirths. In the
absence of access to information on family planning, it is very often
midwives who also act as the carriers of information on various issues
like contraception and HIV. Public health experts in countries like
India and even the Indian government recognized the role of family planning
providers in also disseminating HIV prevention education and services,
including testing, allowing this information to reach more people at
risk of HIV.

What are the implications of
the global gag rule (GGR) here? The
GGR in effect is snatching from women their only access to information
and help on the subject, especially since these family planning workers
are often better positioned to prevent new infections among women and
youth – also the more vulnerable groups.

The problem with clauses
such as the global gag rule and prostitution pledge is that they give little
maneuvering space to groups and organizations implementing the programs. These groups and organizations must ensure that the aid reaches those most in need yet, ironically, the aid ties the programs down by their embedded conditionalities, ultimately making
them ineffective as they reach the least number in more time instead
of the most in the least time.

The fight against the virus is not
simply a matter of a successful morality lecture. Whom are we attempting
to impact ultimately? All those who require this care or simply those
who have made "morally correct" choices? Sustainable
development in countries like India is hinged on family planning policies
and a rights-based approach to HIV/AIDS. Can the implementation of any
program towards controlling the virus be guided by a set of "dos
and don’ts" or of disciplining certain groups (by denying them
aid) for not leading a moral life, according to some?

A more significant danger of bills
like PEPFAR is that they do find support amidst the more conservative
pressure groups and policy planners in the country. So the focus could
very easily be shifted from universal access to medical care, to practices similar to abstinence only, the prostitution pledge or abortion
relegating more controversial measures
to the background. The $50 billion effort of PEPFAR should ensure wider
information and access to HIV/AIDS treatment as the immediate need and
any denial of either funds or treatment to certain groups
is an infringement on basic human rights.

There are critical choices that the
new government has to make; choices that might reverse not just trends
in the developing world with relation to maternal health but also as
a consequence impact the health of the families they form, the communities
they inhabit and the society they build.

News Politics

Missouri ‘Witch Hunt Hearings’ Modeled on Anti-Choice Congressional Crusade

Christine Grimaldi

Missouri state Rep. Stacey Newman (D) said the Missouri General Assembly's "witch hunt hearings" were "closely modeled" on those in the U.S. Congress. Specifically, she drew parallels between Republicans' special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life.

Congressional Republicans are responsible for perpetuating widely discredited and often inflammatory allegations about fetal tissue and abortion care practices for a year and counting. Their actions may have charted the course for at least one Republican-controlled state legislature to advance an anti-choice agenda based on a fabricated market in aborted “baby body parts.”

“They say that a lot in Missouri,” state Rep. Stacey Newman (D) told Rewire in an interview at the Democratic National Convention last month.

Newman is a longtime abortion rights advocate who proposed legislation that would subject firearms purchases to the same types of restrictions, including mandatory waiting periods, as abortion care.

Newman said the Missouri General Assembly’s “witch hunt hearings” were “closely modeled” on those in the U.S. Congress. Specifically, she drew parallels between Republicans’ special investigative bodies—the U.S. House of Representatives’ Select Investigative Panel on Infant Lives and the Missouri Senate’s Committee on the Sanctity of Life. Both formed last year in response to videos from the anti-choice front group the Center for Medical Progress (CMP) accusing Planned Parenthood of profiting from fetal tissue donations. Both released reports last month condemning the reproductive health-care provider even though Missouri’s attorney general, among officials in 13 states to date, and three congressional investigations all previously found no evidence of wrongdoing.

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Missouri state Sen. Kurt Schaefer (R), the chair of the committee, and his colleagues alleged that the report potentially contradicted the attorney general’s findings. Schaefer’s district includes the University of Missouri, which ended a 26-year relationship with Planned Parenthood as anti-choice state lawmakers ramped up their inquiries in the legislature. Schaefer’s refusal to confront evidence to the contrary aligned with how Newman described his leadership of the committee.

“It was based on what was going on in Congress, but then Kurt Schaefer took it a step further,” Newman said.

As Schaefer waged an ultimately unsuccessful campaign in the Missouri Republican attorney general primary, the once moderate Republican “felt he needed to jump on the extreme [anti-choice] bandwagon,” she said.

Schaefer in April sought to punish the head of Planned Parenthood’s St. Louis affiliate with fines and jail time for protecting patient documents he had subpoenaed. The state senate suspended contempt proceedings against Mary Kogut, the CEO of Planned Parenthood of St. Louis Region and Southwest Missouri, reaching an agreement before the end of the month, according to news reports.

Newman speculated that Schaefer’s threats thwarted an omnibus abortion bill (HB 1953, SB 644) from proceeding before the end of the 2016 legislative session in May, despite Republican majorities in the Missouri house and senate.

“I think it was part of the compromise that they came up with Planned Parenthood, when they realized their backs [were] against the wall, because she was not, obviously, going to illegally turn over medical records.” Newman said of her Republican colleagues.

Republicans on the select panel in Washington have frequently made similar complaints, and threats, in their pursuit of subpoenas.

Rep. Marsha Blackburn (R-TN), the chair of the select panel, in May pledged “to pursue all means necessary” to obtain documents from the tissue procurement company targeted in the CMP videos. In June, she told a conservative crowd at the faith-based Road to Majority conference that she planned to start contempt of Congress proceedings after little cooperation from “middle men” and their suppliers—“big abortion.” By July, Blackburn seemingly walked back that pledge in front of reporters at a press conference where she unveiled the select panel’s interim report.

The investigations share another common denominator: a lack of transparency about how much money they have cost taxpayers.

“The excuse that’s come back from leadership, both [in the] House and the Senate, is that not everybody has turned in their expense reports,” Newman said. Republicans have used “every stalling tactic” to rebuff inquiries from her and reporters in the state, she said.

Congressional Republicans with varying degrees of oversight over the select panel—Blackburn, House Speaker Paul Ryan (WI), and House Energy and Commerce Committee Chair Fred Upton (MI)—all declined to answer Rewire’s funding questions. Rewire confirmed with a high-ranking GOP aide that Republicans budgeted $1.2 million for the investigation through the end of the year.

Blackburn is expected to resume the panel’s activities after Congress returns from recess in early September. Schaeffer and his fellow Republicans on the committee indicated in their report that an investigation could continue in the 2017 legislative session, which begins in January.

Analysis Law and Policy

Federal Court Says Trans Worker Can Be Fired Based on Owner’s Religious Beliefs

Jessica Mason Pieklo

“Plain and simple, this is just discrimination against a person because of who she is,” said John Knight, the director of the LGBT and HIV Project of the American Civil Liberties Union of Illinois, in an interview with Rewire.

When the U.S. Supreme Court ruled in 2014 in Burwell v. Hobby Lobby that the owners of secular for-profit businesses could challenge laws they believed infringed on their religious liberties, civil rights advocates warned that the decision was just the start of a new wave of litigation. On Thursday, those predictions came true: A federal district judge in Michigan ruled that a funeral home owner could fire a transgender worker simply for being transgender.

The language of the opinion is sweeping, even if the immediate effect of the decision is limited to the worker, Aimee Stephens, and her boss. And that has some court-watchers concerned.

“Plain and simple, this is just discrimination against a person because of who she is,” said John Knight, the director of the LGBT and HIV Project of the American Civil Liberties Union of Illinois, in an interview with Rewire.

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According to court documents, Stephens, an employee at Detroit’s R.G. & G.R. Funeral Homes, gave her boss—the business’ owner—a letter in 2013 explaining she was undergoing a gender transition. As part of her transition, she told her employer that she would soon start to present as a woman, including dressing in appropriate business attire at work that was consistent both with her identity and the company’s sex-segregated dress code policy.

Two weeks later, Stephens was fired after being told by her boss that what she was “proposing to do” was unacceptable and offensive to his religious beliefs.

In September 2014, the Equal Employment Opportunity Commission (EEOC) filed a lawsuit on behalf of Stephens, arguing the funeral home had violated Title VII of the federal Civil Rights Act, which prohibits employment discrimination. According to the EEOC, Stephens was unlawfully fired in violation of Title VII “because she is transgender, because she was transitioning from male to female, and/or because she did not conform to the employer’s gender-based expectations, preferences, or stereotypes.”

Title VII of the Civil Rights Act allows those employees who have been discriminated against in the workplace to collect money, known as civil damages. Those damages usually come in the form of lost wages, back pay, and funds to make up for—to some degree—the abuse the employee faced on the job. They are also designed to make employers more vigilant about their workplace culture. Losing an employment discrimination case for an employer can be expensive.

But attorneys representing Stephens’ employer argued that the Religious Freedom Restoration Act (RFRA) protected their client from legal liability for firing Stephens. On Thursday, a federal court agreed. It said that paying such damages for unlawfully discriminating against an employee could amount to a substantial burden on an employer’s religious beliefs. 

According to the court, despite the fact that Stephens’ boss admitted he fired her for transitioning, and despite the fact that the court found this admission to be direct evidence of employment discrimination, RFRA can be a defense against that direct discrimination. To use that defense, the court concluded, all the funeral home owner had to do was assert that his religious beliefs embraced LGBTQ discrimination. The funeral home had “met its initial burden of showing that enforcement of Title VII, and the body of sex-stereotyping case law that has developed under it, would impose a substantial burden on its ability to conduct business in accordance with its sincerely-held religious beliefs,” the court wrote.

In other words, Hobby Lobby provides employers a defense to discriminating against LGBTQ people on the basis of religious beliefs.

“The RFRA analysis is extremely troubling, and the implications of it [are] as well,” said Knight. “I believe this is the first case applying RFRA to a Title VII claim with respect to nonministerial employees.”

If the scope of the opinion were broader, Knight continued, “this would allow [employers in general] to evade and refuse to comply with uniform nondiscrimination law because of their religious views.”

This, Knight said, is what advocates were afraid of in the wake of Hobby Lobby: “It is the concern raised by all of the liberal justices in the dissent in Hobby Lobby, and it is what the majority in Hobby Lobby said the decision did not mean. [That majority] said it did not mean the end of enforcement of nondiscrimination laws.”

And yet that is exactly what we are seeing in this decision, Knight said.

According to court documents, Stephens’ boss has been a Christian for more than 65 years and testified that he believes “the Bible teaches that God creates people male or female,” that “the Bible teaches that a person’s sex is an immutable God-given gift, and that people should not deny or attempt to change their sex.” For Stephens’ former boss, Stephens’ transition to a woman was “denying” her sex. Stephens had to be fired, her boss testified, so that he would not be directly complicit in supporting the idea that “sex is a changeable social construct rather than an immutable God-given gift.”

If the “complicit in denying God’s will” sounds familiar, it should. It has been the exact argument used by businesses challenging the birth control benefit of the Affordable Care Act. Those business owners believe contraception is contrary to God’s will and that complying with federal law, which says birth control should be treated in insurance policies as any other preventive service, makes them complicit in sin. Thursday’s decision cites Hobby Lobby directly to support the court’s conclusion that complying with federal nondiscrimination law can be avoided by asserting a religious objection.

Think of the implications, should other courts follow this lead. Conservatives have, in the past, launched religious objections to child labor laws, the minimum wage, interracial marriage, and renting housing to single parents—to name a few. Those early legal challenges were unsuccessful, in part because they were based on constitutional claims. Hobby Lobby changed all that, opening the door for religious conservatives to launch all kinds of protests against laws they disagree with.

And though the complaint may be framed as religious objections to birth control, to LGBTQ people generally, and whatever other social issue that rankles conservatives, these cases are so much more than that. They are about corporate interests trying to evade regulations that both advance social equity and punish financially those businesses that refuse to follow the law. Thursday’s opinion represents the next, troubling evolution of that litigation.

CORRECTION: This article has been updated to clarify John Knight’s position with the American Civil Liberties Union of Illinois.


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